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Integration of oncology and palliative care: a Lancet Oncology Commission

Kaasa, Stein; Loge, Jon H; Aapro, Matti; Albreht, Tit; Anderson, Rebecca; Bruera, Eduardo; Brunelli, Cinzia; Caraceni, Augusto; Cervantes, Andrés; Currow, David C.; Deliens, Luc; Fallon, Marie; Gómez-Batiste, Xavier; Grotmol, Kjersti S; Hannon, Breffni; Haugen, Dagny F; Higginson, Irene J; Hjermstad, Marianne J; Hui, David; Jordan, Karin; Kurita, Geana P; Larkin, Philip J; Miccinesi, Guido; Nauck, Friedemann; Pribakovic, Rade; Rodin, Gary; Sjøgren, Per; Stone, Patrick; Zimmermann, Camilla; Lundeby, Tonje


Stein Kaasa

Jon H Loge

Matti Aapro

Tit Albreht

Rebecca Anderson

Eduardo Bruera

Cinzia Brunelli

Augusto Caraceni

Andrés Cervantes

David C. Currow

Luc Deliens

Marie Fallon

Xavier Gómez-Batiste

Kjersti S Grotmol

Breffni Hannon

Dagny F Haugen

Irene J Higginson

Marianne J Hjermstad

David Hui

Karin Jordan

Geana P Kurita

Philip J Larkin

Guido Miccinesi

Friedemann Nauck

Rade Pribakovic

Gary Rodin

Per Sjøgren

Patrick Stone

Camilla Zimmermann

Tonje Lundeby


Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.


Kaasa, S., Loge, J. H., Aapro, M., Albreht, T., Anderson, R., Bruera, E., …Lundeby, T. (2018). Integration of oncology and palliative care: a Lancet Oncology Commission. The lancet oncology, 19(11), e588-e653.

Journal Article Type Article
Acceptance Date May 16, 2018
Online Publication Date Oct 18, 2018
Publication Date 2018-11
Deposit Date Apr 9, 2019
Journal The Lancet Oncology
Print ISSN 1470-2045
Electronic ISSN 1474-5488
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 19
Issue 11
Pages e588-e653
Public URL
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Additional Information This article is maintained by: Elsevier; Article Title: Integration of oncology and palliative care: a Lancet Oncology Commission; Journal Title: The Lancet Oncology; CrossRef DOI link to publisher maintained version:; CrossRef DOI link to the associated document:; CrossRef DOI link to the associated document:; CrossRef DOI link to the associated document:; CrossRef DOI link to the associated document:; CrossRef DOI link to the associated document:; Content Type: article; Copyright: © 2018 Elsevier Ltd. All rights reserved.